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Step 2 CK renal > R1 > Flashcards

R1 Flashcards

1
Q
  1. Renal artery stenosis is common in?
A
  1. Patient with diffuse atherosclerosis
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2
Q
  1. First-line treatment in case of RAS induced HTN
A
  1. ACE inhibitor (safe in unilateral (just follow RFT) and bilateral until CR raise less than 30%)
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3
Q
  1. Mechanism
A
  1. Inhibit the RAAS which cause the HTN in RAS
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4
Q

. Why is RAAS activated in case of RAS

A
  1. (to maintain GFR by constricting efferent arteriole)
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5
Q
  1. Benefit
A
  1. Reduce HTN, decrease the risk of Ce. V and Ca. V complication
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6
Q
  1. Other additional Tx
A
  1. Treat DM, Additional antihypertensive for control of B/P, Tx hyperlipidemia and smoking section
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7
Q

1.When to consider Surgical revascularization and stunting

A
  1. Failure of medical therapy, recurrent flash pulmonary edema, and CHF secondary to HTN
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8
Q
  1. Why we didnt consider as primary therapy
A
  1. No outcome d/c with that of medical therapy
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9
Q
  1. Symptom and sign of salicylate toxicity
A
  1. Tinnitus, fever and tachypnea
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10
Q
  1. Acid base disturbance?
A
  1. Respiratory alkalosis(stimulate respiratory center) with metabolic acidosis(decoupling of oxidative phosphorylation)—Near normal PH, Low pco2 and low HCO3
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11
Q

How we asses presence of Respiratory alkalosis in presence of Metabolic acidosis?

A

Use winter formula to asses expected Paco2 level?

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12
Q

winter formula?

A

PaCO2=1.5xHCO3 + 8 +-2

if PaCO2< expecter suspect concomitant respiratory alkalosis

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13
Q

How to asses concomitant respiratory acidosis in case of metabolic alkalosis?

A

Change in PaCO2=0.7 x change in HCO3(assuming the Normal HCO3 is 24)
Took the normal CO2 range of 33-45

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14
Q

metabolic acidosis classification?

A

normal anion gap(8-12)

high anion gap(>12)

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15
Q

anion gap calculation?

A

Na -(Cl + Hco3)

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16
Q

High anion gap cause?

A 
GOLDMARK
Glycol(ethylene and proline)
Oxopeoline(a metabolite of acetaminophen)
Lactic Acidosis
D-Lactate(exogenous)
M-methanol and other alcohol
Asprin
Renal failure
Ketone
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17
Q

Normal AGMA?

A 
HARDASS
Hyperlimation(hypochloremia)
Addison disease
Renal tubular acidosis
Diharoa
Acetazolamide
Saline infusion
Spironolactone
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18
Q

Menifestation of diuretic abuse?

A 
hypovolemia
Hyponatremia
Hypokalemia
Hopoclorimia
But will have high urinary Na, K but vary CL
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19
Q

A disease that causes high urine NA despite hyponnatremia?

A

Diuretics
Adrenal insufficiency
Cerebral salt wasting syndrome

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20
Q

Disease that cause high urine K level despite hypokalimia?

A

Diuretics
Primary adrenal insuficiency
Renal tubular acidosis

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21
Q

cause of hypochloremia?

A

Diuretics
Contraction alkalosis
In both cases, the urine concentration can vary

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22
Q

the factor that causes hypokalemia, alkalosis, and normotension?

A

1-sever vomiting
2-Diuretics abuse
3-Gitelman’s syndrome
4-Bartter syndrome

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23
Q

1-serpitious vomiting evidence ?

A

scar/callus in dorsum of hand
dental erosion
hypochlorimia and low urine CL

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24
Q

2-Diuretics abuse, Gitelmans syndrome

and Bartter syndrome?

A

High urine CL level

25
Q

What about primary primary hyperaldostronism?

A

Hypokalemia.Metabolic alkalosis but have HTN

26
Q

Bartter syndrome?

A 
Reabsorption defect in thick ascending
loop of Henle (affects Na+/K+/2Cl–
cotransporter)
Metabolic alkalosis,
hypokalemia,
hypercalciuria
Autosomal recessive Presents similarly to chronic loopdiuretic usage
27
Q

Gitelman syndrome?

A 
Reabsorption defect of NaCl in DCT
Metabolic alkalosis,
hypomagnesemia,
hypokalemia,
hypocalciuria
Autosomal recessive Presents similarly to
lifelong thiazide
diuretic use
Less severe than Bartter
syndrome
28
Q

How to d/t barrtner from gitelman?

A

B-Hypercaceiuria

G-Hypocalciuria

29
Q

Hepatorenal syndrome manifestation?

A

End-stage liver disease
w/o clear cause identified
minimal haematuria
lack of improvement with resuscitation

30
Q

pathophysiology?

A

difiuse pheripherial vasodilation mainley splancnic—RAAS activation==Renal hypoperfusion—decrease renal perfusion and low GFR–AKI

31
Q

managment?

A

Liver transplantatioin candidate
stop liver injuring practice
Splancnic vasoconstricting agent(octeriotide, midodrine,NE) and albumine

32
Q

Common initiating factor?

A

upper GI bleeding

SBP

33
Q

winter formula?

A

asses RA compensation in case of MA

34
Q

change in HCO3)x 0.7?

A

respiratory acidosis Compensation in case of Metabolic alkalosis

35
Q

when to intubate patient with metabolic acidosis?

A

shalow and fast breathing

concomitant respiratory acidosis

36
Q

ECG feucher of hyperkalemia?

A 
Tall picked T wave
Prolonged PR, wide QRS, and short QT
Disappearance of P wave
Conduction block
bradycardia
Ectopic beat
Sine wave pattern
37
Q

Emergency hyperkalemia managmnt?

A

Indicated when K level >6.5 mEq/L
Iv calcium Cloride/gluconate–Membrane stabilization
IV inuline with glucose
Beta agonist(albuterol)

38
Q

mechanism to lower body K level?

A

1) Reversal of etiology like prerenal azotemia
2) Diuretics
3) Exchange resins
4) Heamodialysis

39
Q

use of serum osmolar GAP?

A

To identify causes(methanol,ethanol, and ethylene glycol) suspected in case of anion gap MA.

40
Q

use of urine anion gap ?

A

To identifi cause of non anion gap MA

calculated as urine Na+K-CL

41
Q

If posetive?

A

caused by renal loss like RTA and Acetazolamide

42
Q

If negative ?

A

Caused by GI bicarbonate loss

43
Q

Renal complication of SLE?

A

DNA and anti DNA IC deposition
If above BM–Glomerulonephritis
If below BM–Nephrotic syndrome

44
Q

first generation antihistamin in BPH/older patient?

A

can cause AUR b/c of anticolinergic effect
Durtusor muscle dysmotility
Impaired IUS relaxation

45
Q

cause of hyponatremia evaluation?

A

asses urine and serum osmolarity

46
Q

serum osmolarity > 290

A

marked hyperglycemia

ARF

47
Q

if urine osmolarity <100 (diluted)

A

primary polydipsia

malnutrition(post alcohol protiomania)

48
Q

if urine osmolarity > 100

A

asses urine Na

49
Q

if urine Na <25 meq/l?

A

DHN
CHF
Cirhosis

50
Q

If urine Na >25 meq/L

A

SIADH
HYpothyroiism
Adrenal insuficienct

51
Q

CM of ADPKD?

A 
flank pain
hematuria
HTN
palpapele abdominal mass
CKD
nocturia and frequency due to defect in renal consentration of urine capablity
52
Q

extrarenal feaucher?

A 
cerebral anurythm
liver and pancriatic cyst
MVP and AR
colonic diverticulosis
ventral and inguinal hernia
53
Q

managment of HTN in ADPKD?

A

ACE inhibitors

54
Q

How to d/t glomerular from non glomerular hematuria?

A

IN GH
protine positive
dysmorphic RBC
RBC cast

55
Q

managment of acute cystitis in NP womens?

A 
Nitrofurantoin
TM-CTM
fosomycine single dose
FQ if abovw managment fails
Urine culture if initial tx failure
56
Q

complicated cystiti?

A

prolonged FQ
broad spectrum ab(ampi genta)
urine culture

57
Q

pyelonephritis?

A

FQ
IV ceftra
urine culture and sensitivity

58
Q

RCC sighn and symptome?

A 
flank hematuria
flank pain
palpable mass
left side scrotal varicosele
paraneoplastic syndrome
59
Q

paraneoplastic syndrome?

A 
erythrocytosis and anemia
thrombocytosis
fever
hypercalcemia
cachexia

Step 2 CK renal (5 decks)

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